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Table 3 Summary of selected studies

From: Observer roles that optimise learning in healthcare simulation education: a systematic review

Reference Research paradigm, design & samplinga Participants Intervention Learner Observation Style Results
Bell, Pascucci, Fancy, Coleman, Zurakowski and Meyer [24] Mixed methods Health professionals from four disciplines (n = 192) Use of improvisational actors in difficult conversations to teach communication and relational skills to practicing health professional Non-directed role: no use of observational tool or verbal guidance reported No difference between observers and hands on learners in: perceived realism; usefulness of actors; usefulness of scenarios; and, opinions on non-actor role play
Post-simulation survey design with qualitative and quantitative analysis Teaching faculty (n = 33)
Convenience sample Actors (SP) (n = 10)
Hands on participants (47 %)
Observers (53 %)
Harder, Ross and Paul [25] Ethnographic stud Bachelor of Nursing students year 3 (n = 84) Role assignment within regular simulation session with analysis of experience and perceptions of learning within different role Non-directed role: no use of observer tool or verbal guidance reported Students preferred assignment to nursing roles rather than observer or non nursing role
Observational design with focused interview and journal review of selected participants Participant/observation (n = 84) interview (n = 12) All participants experienced both roles   Structured role descriptions positively affected learning outcomes
Volunteer sample journal review (n = 4)
Hober and Bonnel [11] Qualitative Bachelor of Nursing “senior” students (n = 50) Immersive simulation scenarios with students randomly assigned to active or observer roles Directed observer role: observer tool – educator provided activity guidelines Observer role beneficial, less stressful
Survey and interview design Observers (n = 23) All completed survey Use of a guided observer tool useful
Convenience sample hands on learners (n = 27) Observers interviewed   Able to reflect in action and on action
Kaplan, Abraham and Gary [27] Quantitative Bachelor of Nursing “junior” students (n = 92) Immersive simulation scenarios - Directed observer role: observer tool -checklist No difference in knowledge
Randomised groups Observers (n = 46) participants self selected roles
Convenience sample Scenario participants (n = 46) Unclear whether observers self selected or were assigned Limited as aggregated post satisfaction survey data
Post scenario knowledge test and satisfaction survey
Lau, Stewart and Fielding [22] Quasi experimental randomised to roles Medical students (bilingual) year 1 (n = 160) Student role plays with comparison of learning between interpreter role play and observer role Directed observer role: observer tool -checklist Observers rated post knowledge higher than learners in interpreter role-play
Convenience sample Self rated pre & post knowledge
Smith, Klaassen, Zimmerman and Cheng [26] Mixed methods with increasing variables over three years Bachelor of Nursing “junior” students Introduction of simulation year 1 Non-directed role: no use of observational tool or verbal guidance reported No significant difference in learning outcomes, student perceptions or peer evaluations
Introduction non nursing participatory roles year
Convenience sample year 1 (n = 67) Introduction non participatory observer roles year 3
year 2 (n = 72)
year 3 (n = 85)
Note only the year 2 and 3 data were included in review
Stegmann, Pilz, Siebeck and Fischer [20] Quantitative Medical students (n = 200) Comparison of participatory role and observer role in simulated patient scenario with and without observation tool Non-directed and directed observer roles compared: checklists and feedback scripts used Observational learning (especially if supported by observer script) more effective than learning by doing
Crossover design 2x2x2 pre-test post-test
Stiefel, Bourquin, Layat, Vadot, Bonvin and Berney [23] Quantitative Medical students (masters level) (n = 124) Individual training with simulated patient encounter Non-directed role: no use of observer tool or verbal guidance reported Measured outcomes no difference
Randomised into 2 group Individual training (n = 49) Group training (n = 75) -participated in simulation (n = 14) observed (n = 61) Group training with simulated patient encounter Those who observed but did not participate felt they did not meet their learning objectives as well compared to the other 2 groups
Evaluation using instructor rating scale and student questionnaire Group training with observation of simulated encounter
Convenience sample
Thidemann and Soderhamn [21] Quasi experimental Bachelor of Nursing student year 2 (n = 144) Immersive mannequin simulation with random allocation to groups Directed observer role: observer tool with specific task focus Post-test scores higher in all groups independent of rol
Pre - and post-simulation knowledge test and student questionnaire Four volunteers within each group allocated to participatory and in scenario observer roles – remainder observers (n = 72) More satisfaction with nurse role
Convenience sample over two consecutive years
  1. aas attributed by author where available